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Lege Artis Medicinae

JULY 20, 2019

[The red eye]

IMRE László

[Eye redness may be a sign of a variety of eye diseases with different severity. Most often redness is relatively harmless, such as conjunctivitis, but it can be a serious illness with visual impairment and even lasting consequences in the background of redness. It is therefore important for non-ophthalmologists to be informed and to know the basic types of redness of the eye and to recognize typical and characteristic forms of appearance. Based on these, they can decide whether the patient can be treated or forwarded to an ophthalmic institution. In the present continuing education article we try to summarize the causes of the red eye, primarily according to the characteristics of the redness of the eye and the anatomical localization. During the investigation of a patient with red eye, the type of the redness can be determined most by diffuse illumination and by naked eye inspection without any other means. It is important to know the principal features and causes of redness of conjunctival or ciliary or scleral origin, possible other recognizable differences (e.g. conjunctival papillae or follicles or conjunctival chemosis). We have attempted to illustrate these with a number of photographs, starting with a schematic representation of the characteristic features of redness. We tried to emphasize cases suitable for treating by non-ophthalmologists and tried to draw attention to the importance of referral un­clear or complicated cases.]

Lege Artis Medicinae

MAY 20, 2019

[Perinatal faulty hormonal imprinting: early impact, late consequences]

CSABA György

[The description and basic study of hormonal imprinting were the first in the series of research, which led to the recognition of the role of perinatal chemical effects in the late (adult age) manifestation of some diseases and inclination to diseases. Today it is clear, that certain pathological states, as obesity or diabetes, hypo- or hyperactivity (autoimmunity and allergy) of immune system can be deduced to perinatal (hormonal or metabolic) imprinting. The perinatal hormonal (chemical) imprinting takes place at the first encounter between the developing hormone receptor and the target hormone which sets the binding capacity of the receptor for life. In the critical periods of ontogeny (in addition to the perinatal imprinting) it can be developed at weaning, in adolescence and in continuously dividing and differentiating cells during the whole life. It is provoked by considerable quantitative differences of the physiological hormone or the presence of strange target-hormone-like molecules. The faulty hormonal imprinting leads to the adult-age diseases at any time of life and is inherited epigenetically to the progeny generations. Faulty hormonal imprinting always could be present in earlier times however, at present, because of the erroneous multiplication of endocrine disruptors in the environment, nutrition and medicine, its importance is continuously growing. The effects of faulty hormonal imprinting seem to be dangerous however, it can be imagined in the far future also a positive effect by the transformation of the human endocrine system at an evolutionary route. In the metabolic or immunological imprinting as well, as in the DOHaD (Developmental Origins of Health and Disease) the foremost recognized hormonal (chemical) imprinting is materialized.]

Clinical Neuroscience

JANUARY 30, 2018

[Effects of nasal provocation with a single-dose allergen on the explicit and implicit memory of physically active and inactive patients with ragweed allergy]

TOKODI Margaréta, CSÁBI Eszter, KIRICSI Ágnes, SCHULTZ Rebeka, MOLNÁR H Andor, ROVÓ László, BELLA Zsolt

[Background and purpose - Allergy is an endemic disease and has a considerable impact on the quality of life. This study aimed to measure the effect of active allergic rhinitis on memory functions of physically active and inactive patients with ragweed allergy. Methods - Memory functions were assessed before and after allergen exposure. Participants in both groups were provoked nasally with 30 IR/mL ragweed allergen in each nostril. Explicit memory was measured with story-recalling and implicit memory was investigated with reaction time task. Results - In neuropsychological assessments athletes performed significantly better, compared with the control group after allergen provocation in short-term and long-term memory functions. There was no difference between the groups in the implicit tasks. Athletes have achieved better results after provocation, comparing to the baseline test and the tests that measured short-term and long-term memory functions. Conclusion - Short-term disturbing factors, e.g. swollen nasal mucosa, sneezing, and watery eyes after provocation did have not caused deterioration in cognitive functions. A single-shot allergen in high doses have caused an increase of mental concentration, which was more pronounced in athletes.]

Clinical Oncology

FEBRUARY 15, 2016

[Oncotherapy associated skin toxicity]

OLÁH Judit

[The last decades opened a new era of oncotherapy, including the development of targeted therapies for different subtypes of malignancies. Cutaneous adverse events are the most frequent toxicities among side effects of personally tailored molecular targeted agents. This review summarizes the practical aspects of the clinical characteristics and the optimal treatment of skin-related complications caused by oncological drugs.]

Lege Artis Medicinae

SEPTEMBER 22, 2013

[A novel rapid IL-6 release assay using blood mononuclear cells of patients with various forms of drug induced skin injuries]

BALÓ-BANGA J. Mátyás, SCHWEITZER Katalin

[INTRODUCTION - IL-6 is a multifunctional cytokine with effects on the haematopoiesis on differentiation of T and B lymphocytes and on the regulation of both inflammatory and allergic reactions. The question arose whether this substance excreted by mononuclear cells could be used as a marker of allergy to drugs or not. Till now equivocal descriptions were lacking. METHOD - The preformed IL-6 present in the mononuclear cells released by any of four standard dilutions of pure substances upon 20 minutes incubation was determined from the supernatants by ELISA technique. In vivo patch, intradermal and provocation tests were carried out along with this assay (483 in vitro and 172 in vivo). RESULTS - Two different groups suspect for drug allergy (100 and 62 patients as well as their matching controls, 24 and 23 persons) were involved with these procedures. In some cases TNF-α, IL-2, IFN-γ and IL-4 was measured simultaneously by flow cytometric assay. Only TNF-α and IL-6 were present in the 20 min. supernatants. The comparisons with in vivo tests have confirmed that the amount of IL-6 release had not depended either on the clinical phenotype of allergy or on the structure of the tested drugs within the molecular mass range between 76-4000 Da. IL-6 released at the lowest or multiple concentrations of drugs coincided with more severe and widespread clinical forms. CONCLUSION - Based on the results we elaborated an in vitro method applicable clinically for detecting drug sensitisation and its differential diagnosis in patients with skin signs of drug sensitisation.]

Lege Artis Medicinae

AUGUST 20, 2003

[Diagnosis and therapy of insect sting allergy]

BÁNKÚTI Beáta

[Over the past 20 years great progress has been made in understanding the pathogenesis, diagnosis and treatment of allergic reactions caused by insect stings. The incidence of insect sting allergy in a general population is about 0.4- 3% but anaphylaxis to Hymenoptera venom can be fatal. The diagnosis of venom allergy is based on the history suggesting an allergic reaction and on the demonstration of the persistence of specific IgE antibody either by skin tests or RAST. Patients who had a severe allergic reaction and has positive venom skin test or RAST result should be advised to receive venom immunotherapy (VIT). The risk for subsequent life-threatening systemic sting reactions can be significantly reduced with VIT. VIT should be continued for at least 3 to 5 years and provides about 90 % protection from insect sting anaphylaxis.]

Hungarian Immunology

JANUARY 22, 2008

[Pseudolymphoma orbitae]

VÁNCSA Andrea, GERGELY Lajos, NEMES Zoltán, BÍRÓ Edit, ILLÉS Árpád, BAKÓ Gyula

[INTRODUCTION - Pseudolymphoma orbitae is a rare and difficult entity. The cooperation of the pathologist and clinician is needed to properly manage the patient. CASE REPORT - The authors report the case history of a 38 years old male patient. His disease started at the age of 30. He was previously treated with allergic rhinitis. No definitive diagnosis was made for eight years. Several surgical biopsies were made from nasal mucosa, but no specific histologyical diagnosis was applicable. At the age of 30 he developed an unilateral exophthalmus on the left side. Thyroid associated ophthalmopathy was ruled out several times with laboratory analysis. High dose methylprednisone therapy was repeatedly given with limited results. At the age of 34 orbital CT and MRI scan confirmed the pseudotumour orbitae already compressing the optical nerve. Laboratory analysis again ruled out thyroid associated ophthalmopathy. Churg-Strauss syndrome, Wegener’s granulomatosis or Sjögren’s syndrome could be ruled out. A bone marrow trephine biopsy excluded systemic hematological disease as well. A biopsy was performed from the retrobulbar mass again, which confirmed the lymphoid hyperplasia with B-cell dominance. High dose methylprednisone and local irradiation resulted only moderate decrease of the mass, so systemic chemotherapy was started using CVP (cyclophosphamide, vincristin, prednisone) then CHOP (CVP + anthrycycline) polychemotherapy for eight cycles and subcutaneous interferon-α for 20 months. CONCLUSIONS - This resulted a complete regression of the disease, and the patient is well for 48 months now.]

Lege Artis Medicinae

JULY 20, 2002

[Functional genomics - Potentials, hopes, and post genomic realism]

FALUS ANDRÁS, SZALAI Csaba, TÓTH Sára

[This paper provides an overview on major elements of the age of genomics: including the human genome programme, principles of gene chip technology and data management by bioinformatics. The manuscript provides examples from the fields of oncology, infectology and allergy. The possibility of ”in silico” research on computers is also presented with the shadows of the post-genomic era and the significance of changes in the biomedical paradigm.]

Lege Artis Medicinae

FEBRUARY 21, 2006

[PRINCIPLES AND NATIONAL REGULATIONS OF BLOOD DONOR QUALIFICATION]

TOMONKÓ Magdolna

[During the assessment of blood donor candidates the physician considers two factors; first, whether the loss of 450 ml blood would be of any risk for them (e.g., because of hypotension) and second, whether they have any illness, current (seasonal allergy, antibiotic use, etc.) or chronic conditions (oncological or autoimmune disease, drug use, etc.) that may confer risk to the recipient. For the safety of blood preparations it is essential that the donors are dependable individuals who lead a lifestyle of low risk of getting infected (by HIV, hepatitis, etc.). Hungarian practice concerning donor qualification are generally stricter (e.g., because of the differences in the health care system, in the health culture) than the directive of the European Union. This implies that a number of donor candidates are temporarily or permanently disqualified. Following medical interventions (e.g., surgery, transfusion), environmental effects (e.g., radiation exposure) and recovery from diseases, however, the donor may again give blood after a certain period of time. Certain chronic diseases, if properly managed and if the patient is in perfect general condition, do not constitute a cause for exclusion either. General practicioners can greatly contribute to safe national blood supply by identifying and advising potential blood donors.]

Ca&Bone

APRIL 20, 2002

[Evaluation of bone mineralization in cow’s milk sensitive children]

HIDVÉGI Edit, ARATÓ András, CSERHÁTI Endre, SZABÓ Antal, SZABÓ András, HORVÁTH CSABA

[BACKGROUND - Patients with cow's milk allergy (CMA) form a potential risk group for osteopenia, because their milk-free diet usually has a low calcium content.The study analyses various parameters of bone mineralization in CMA children. PATIENTS AND METHODS - Twenty-seven CMA patients (mean age: 4.3 years, range: 3-8 years) were enrolled in the study.Transient sensitivity to cow's milk was observed in 20 of 27 patients. During the milk-free diet period (mean duration 11.8 months) children were fed by extensively hydrolysed or soy-based formulas. Seven patients still required a cow's milk free diet at the time of the study. Serum levels of Na, K, Cl, Ca, P and Mg ions, as well as of alkaline phosphatase (AP), parathyroid hormone (PTH), osteocalcin and beta-crosslaps were determined for all 27 patients.The values were compared to those of 20 healthy age-matched controls. Bone mineral densities (BMDs) of CMA patients were also measured. RESULTS - The AP and PTH levels were higher in CMA patients than in the control group (AP: 610.2 U/l vs 499.7 U/l, p<0.01; PTH: 1.56 pmol/l vs 0.83 pmol/l, p<0.03), but all values fell in the normal range.The osteocalcin level was similar in the two groups, and the beta-crosslaps was lower in CMA patients than in the controls (0.92 vs 1.47 ng/ml, p<0.001).There was a positive correlation between both AP and osteocalcin and AP and beta-crosslaps levels.The mean Z score of bone mineral density in patients with CMA was -0.6. In 10 cases the Z score was below -1, which was associated with a significantly elevated PTH level compared to the group of patients with a Z score above - 1 (2.24 pmol/l vs 1.16 pmol/l, p<0.03). CONCLUSION - In children with CMA on a cow's milk free diet, slight disturbances of bone mineralization were observed, therefore, osteodensitometric check-up of these children is recommended.]